The Bombing of Hospitals Shows That the Rules of War Are Being Rewritten

Today marks one month since airstrikes by US special forces devastated the trauma hospital run by Medecins Sans Frontieres/Doctors Without Borders (MSF) in Kunduz, Afghanistan. This unprecedented attack on our organisation killed 30 people—10 patients, 13 MSF staff members and seven others whose bodies have yet to be identified. Thirty-seven other people—including 19 MSF staff—were injured. Despite repeated requests by MSF to stop the bombing, the airstrikes continued for more than one hour.

MSF's hospital in Kunduz, open since 2011, was one of the few emergency trauma centres in northeastern Afghanistan. We performed thousands of surgeries every year and provided essential medical assistance to anybody who needed it. When MSF opens a trauma centre in a conflict zone, we always begin by negotiating with all warring parties, asking for the right to treat everyone who needs medical care. Once a patient enters our clinic, the distinction between a civilian or fighter disappears so long as people leave their guns at the door - the precondition for treatment. We will give medical care regardless of a person's origin, religion or political affiliation, as is set out in the Geneva Conventions.

In the week before this terrible attack, 394 people injured in clashes in Kunduz had sought care at the hospital, and the status of the hospital as a protected space had been respected. When the airstrikes began, 105 patients and 80 staff members were inside.

We were outraged when roughly three weeks later, the hospital supported by MSF in Haydan, northern Yemen, was bombed by the Saudi-led coalition. Luckily there was only one minor injury - people had time to evacuate the hospital between airstrikes before it was entirely demolished. It was the only private hospital serving 200,000 people, so its destruction will have terrible and far-reaching consequences on a population which is already facing critical shortages of food, fuel, shelter, water and medical care. It is the 20th hospital in the area to be destroyed in this way.

Soon news came that 12 hospitals in Syria—six of them supported by MSF - had been bombed during October.

Beyond the pain we feel from losing colleagues and patients and the threat this poses to our ability to provide medical care, we are struggling to understand why we were targeted. This is why MSF has been calling for an independent investigation to clarify the circumstances surrounding the attack in Kunduz. Understanding the reasons why our medical facility was targeted is essential to assessing the risks for our teams and our ability to continue working in hostile environments across the world.

In times of war, hospitals and other healthcare facilities are where the most vulnerable - the sick and wounded - are found. They are places of hope and humanity amid violence and chaos. The Geneva Conventions stipulate that functioning hospitals must not be bombed for any reason without prior warning while medical workers and patients are inside. For people caught up in armed conflict, medical facilities provide reassurance that even in the midst of appalling violence, they can safely access treatment.

What are medical workers from Afghanistan to Syria, Yemen and beyond to do if their protection is stripped from them? What does it mean for patients if their ability to access medical care is destroyed?

Unfortunately, the events in Kunduz and Haydan are not isolated cases. The protection of health facilities in conflict zones has been eroded. This tragic and wanton destruction not only affects MSF. It affects the millions of people who are caught up in conflict and all too often, it is patients, doctors, paramedics and support staff who pay the highest price.

Since 1949, the Geneva Conventions have obliged warring parties to protect the wounded and sick, without discrimination and in respect of the rules of medical ethics. They bring some humanity to an otherwise inhumane situation. Is there a concerted effort to rewrite these rules of war?

Today, as we gather outside London's St. Bartholomew's Hospital, Edinburgh's Royal Infirmary and elsewhere across Europe to remember our fallen colleagues and patients, we say that attacks on medical facilities must end.

Vickie Hawkins is the U.K. executive director of Médecins Sans Frontières and the former head of mission in Afghanistan.